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Current Medical Imaging

Author(s): Muhammet Arslan* and Serkan Degirmencioglu

DOI: 10.2174/1573405615666181122145330

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Risk Factors for Postembolization Syndrome After Transcatheter Arterial Chemoembolization

Page: [380 - 385] Pages: 6

  • * (Excluding Mailing and Handling)

Abstract

Background: Transarterial Chemoembolization (TACE) is a minimally invasive treatment in managing unresectable liver primary neoplasms or liver metastases. Postembolization Syndrome (PES) is the most common adverse effect after TACE procedures.

Objective: We investigate the risk factors for the development of PES after TACE therapy in patients with primary or metastatic liver tumors.

Methods: In a retrospective analysis of 163 patients who underwent TACE between 01/01/2012 and 31/01/2018, patients that were given medication due to pain, fever, nausea or vomiting were evaluated and noted with PES. Analyses were made to evaluate factors such as age, gender, chemotherapy agent and dose, tumor size, tumor type, a particle used for embolization, multiple tumor treatments and selective application of the procedure, which may lead to PES after TACE.

Results: In a total of 316 patients, PES was observed at a rate of 55 percent after TACE. Tumor size, number of tumors treated and adopting super selective fashion in the procedure were found to be related to the development of PES. No relationship was found between age, gender, presence of ascites, tumor type, size of embolic agent and drug type and the development of PES.

Conclusion: A treated tumor measuring >5 cm, treating more than one tumor, and the failure to perform the procedure in a super selective fashion increase the risk of PES development after TACE.

Keywords: Postembolization syndrome, transcatheter arterial chemoembolization, liver, complication, cancer, tumor.

Graphical Abstract

[1]
Basile A, Carrafiello G, Ierardi AM, Tsetis D, Brountzos E. Quality-improvement guidelines for hepatic transarterial chemoembolization. Cardiovasc Intervent Radiol 2012; 35(4): 765-74.
[2]
Blackburn H, West S. Management of postembolization syndrome following hepatic transarterial chemoembolization for primary or metastatic liver cancer. Cancer Nurs 2016; 39(5): 1-18.
[3]
Xu L, Wang S, Zhuang L, et al. Decoction alleviated postembolization syndrome following transcatheter arterial chemoembolization for hepatocellular carcinoma: A randomized, double-blind, placebo-controlled trial. Integr Cancer Ther 2016; 15: 349-57.
[4]
Dhand S, Gupta R. Hepatic transcatheter arterial chemoembolization complicated by postembolization syndrome. Semin Intervent Radiol 2011; 28: 207-11.
[5]
Lu W, Li Y, He X, Chen Y. Transcatheter arterial chemoem- bolization for hepatocellular carcinoma in patients with cirrhosis: Evaluation of two kinds of dosages of anticancer drugs and analysis of prognostic factors. Hepatogastroenterology 2003; 50: 2079-83.
[6]
Saccheri S, Lovaria A, Sangiovanni A, et al. Segmental trans- catheter arterial chemoembolization treatment in patients with cirrhosis and inoperable hepatocellular carcinomas. J Vasc Interv Radiol 2002; 13: 995-9.
[7]
Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 2003; 37: 429-42.
[8]
Lima M, Dutra S, Veloso Gomes F, Bilhim T, Coimbra E. Risk factors for the development of postembolization syndrome after transarterial chemoembolization for hepatocellular carcinoma treatment. Acta Med Port 2018; 31: 22-9.
[9]
Mason MC, Massarweh NN, Salami A, Sultenfuss MA, Anaya DA. Post-embolization syndrome as an early predictor of overall survival after transarterial chemoembolization for hepatocellular carcinoma. HPB (Oxford) 2015; 17: 1137-44.
[10]
Yinglu F, Changquan L, Xiaofeng Z, Bai L, Dezeng Z, Zhe C. A new way: Alleviating postembolization syndrome following transcatheter arterial chemoembolization. J Altern Complement Med 2009; 15(2): 175-81.
[11]
Yang H, Seon J, Sung PS, et al. Dexamethasone prophylaxis to alleviate postembolization syndrome after transarterial chemoembolization for hepatocellular carcinoma: A randomized, double-blinded, placebo-controlled study. J Vasc Interv Radiol 2017; 28(11): 1503-11.
[12]
Siriwardana RC, Niriella MA, Dassanayake AS, et al. Factors affecting post-embolization fever and liver failure after trans-arterial chemo-embolization in a cohort without background infective hepatitis-a prospective analysis. BMC Gastroenterol 2015; 15(1): 96.
[13]
Pomoni M, Malagari K, Moschouris H, et al. Post embolization syndrome in doxorubicin eluting chemoembolization with DC Bead. Hepatogastroenterology 2012; 59: 115-6.
[14]
Leung DA, Goin JE, Sickles C, Raskay BJ, Soulen MC. Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol 2001; 12: 321-6.
[15]
Li CP, Chao Y, Chen LT, et al. Fever after transcatheter arterial chemoembolization for hepatocellular carcinoma: Incidence and risk factor analysis. Scand J Gastroenterol 2008; 43: 992-9.
[16]
Jun CH, Ki HS, Lee HK, et al. Clinical significance and risk factors of postembolization syndrome fever in patients with hepatocellular carcinoma. World J Gastroenterol 2013; 19: 284-9.
[17]
Kogut MJ, Chewning RH, Harris WP, Hippe DS, Padia SA. Postembolization syndrome after hepatic transarterial chemoembolization: Effect of prophylactic steroids on postprocedure medication requirements. J Vasc Interv Radiol 2013; 24: 326-31.
[18]
Sohara N, Takagi H, Abe T, et al. Nausea and vomiting induced by arterial chemo-embolization in patients with hepatocellular carcinoma and the antiemetic effect of ondansetron hydrochloride. Support Care Cancer 1999; 7: 84-8.
[19]
Ogasawara S, Chiba T, Ooka Y, et al. A randomized placebo-controlled trial of prophylactic dexamethasone for transcatheter arterial chemoembolization. Hepatology 2018; 67: 575-85.
[20]
Zhou B, Wang J, Yan Z, Shi P, Kan Z. Liver cancer: Effects, safety, and cost-effectiveness of controlled-release oxycodone for pain control after TACE. Radiology 2012; 262: 1014-21.
[21]
Lee SH, Hahn ST, Park SH. Intraarterial lidocaine administration for relief of pain resulting from transarterial chemoembolization of hepatocellular carcinoma: Its effectiveness and optimal timing of administration. Cardiovasc Intervent Radiol 2001; 24: 368-71.
[22]
Zeng K, Dong HJ, Chen HY, Chen Z, Li B, Zhou QH. Wrist-ankle acupuncture for pain after transcatheter arterial chemoembolization in patients with liver cancer: A randomized controlled trial. Am J Chin Med 2014; 42(02): 289-302.
[23]
Castells A, Bruix J, Ayuso C, et al. Transarterial embolization for hepatocellular carcinoma. Antibiotic prophylaxis and clinical meaning of postembolization fever. J Hepatol 1995; 22: 410-5.
[24]
Kallini JR, Gabr A, Thorlund K, et al. Comparison of the adverse event profile of TheraSphere with SIR-Spheres for the treatment of unresectable hepatocellular carcinoma: A systematic review. Cardiovasc Intervent Radiol 2017; 40: 1033-43.
[25]
Piscaglia F, Tovoli F, Pini P, Salvatore V. A new horizon in the prevention of the postembolization syndrome after transcatheter arterial chemoembolization for hepatocellular carcinoma. Hepatology 2018; 67(2): 467-9.
[26]
Lance C, McLennan G, Obuchowski N, et al. Comparative analysis of the safety and efficacy of transcatheter arterial chemoembolization and yttrium-90 radioembolization in patients with unresectable hepatocellular carcinoma. J Vasc Interv Radiol 2011; 22(12): 1697-705.
[27]
Gomes FV, Oliveira JA, Correia MT, et al. Chemoembolization of hepatocellular carcinoma with drug-eluting polyethylene glycol embolic agents: Single-center retrospective analysis in 302 patients. J Vasc Interv Radiol 2018; 29(6): 841-9.